Under The Knife

Hitting Pause

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Jacoby Ellsbury (fractured ribs, TBD)
Ellsbury's notes got as much news as his ribs over the weekend. As he went through his very awkward press conference, Ellsbury showed that he was way off the pages of the Red Sox' songbook. Ellsbury took the time to break down the timeline of his fractured ribs and associated injuries, making sure that it was clear along the way that he thought the Red Sox had dropped the ball. Shortly after, Kevin Youkilis put on record what many other Red Sox are apparently thinking-that Ellsbury was getting the "bad teammate" vibe for not staying with the team and for speaking against the Red Sox medical staff. Ellsbury said many things, but the timeline for his return to the Sox still remains unclear. The strained lat and intracostal that he disclosed give us nothing more to go on. For now, he'll head down to the spring training facility in Ft. Myers. This remains a pain tolerance issue, and several weeks away from the team don't seem to have cleared that up. One source wondered if Ellsbury would be back in time for the Sox to put him up for trade, saying, "he's got to go". This will definitely be a test for the field staff and 'clubhouse leadership' as much as the medical staff.

Jake Peavy (strained lat, ERD 10/4)
Peavy's retracted lat strain is relatively unique, but not quite as unique as I'd thought. A Dodgers farmhand, Brett Leach, had a very similar surgery a few years back, performed by my number three super-surgeon, Dr. Neal ElAttrache. Leach was able to come back without significant difficulty and, according to Kevin Goldstein, he got his velocity back quickly, losing only time to injury. This is definitely a positive indicator for Peavy, and confirms the earlier thought that he'd be able to come back at some point near spring training 2011. I spoke with Dr. ElAttrache about the surgery, and he confirmed most of what I knew: the surgery is relatively simple, a matter of tacking the tendon back into place. Leach has had good results with no setbacks of any type, and if Peavy recovers on a similar timeline, he'll be back at 100 percent by next spring. Dr. ElAttrache wasn't sure that the run of lat strains that we've had lately was more than coincidence, but he noted that the lat is both an accelerator and a decelerator in the shoulder, an unusual circumstance. None of the training programs that most pitchers do have any specific activities for the lat the way that many focus on the rotator cuff, so it's a possibility if this turns out to be a sign that the lat is breaking down within the kinetic chain.

Zack Greinke (strained shoulder, ERD TBD)
Hearing "scratched due to sore shoulder" is never good for any pitcher. For an ace-level guy like Greinke, it's even scarier. While the Royals insist that Greinke being held out of his weekend start was merely a precaution, there's going to be panic that the precaution was even necessary. The Royals are on full lockdown about specifics of this, so details are sketchy despite my best digging. The team is hoping that rest will get him back and ready to go, which indicates a muscular problem rather than a structural one. That's a mildly good sign, and there's not much else to go on. We probably won't get an indicator on his throw day due to the off days, but we'll see how the Royals re-set their rotation later in this week, which will function as a tell.

Jose Reyes (strained oblique)
Reyes has pulled out of the ASG due to his continuing struggles with a mild oblique strain. Yes, mild. The Mets have allowed him to keep playing through it because images and other tests show it to be mild. That doesn't mean it's less painful or less dangerous if Reyes does manage to exacerbate it, but it's an educated gamble on the Mets' part. It's also the first sign that the Mets are getting out of the shadows of last season's injuries and acting like a normal baseball team. Reyes has already given up switch-hitting to try and make sure that he doesn't exacerbate the injury, so a few extra days of rest should help here. The Mets will be watching closely and looking for ways to buy him some rest, but outside of that, Reyes looks to be able to play at some level through the injury.

Adrian Beltre (strained hamstring, ERD TBD)
Miley Cyrus aside, not all pop is bad. You'll often hear a player describing feeling something "pop," as Beltre did with his hamstring. It's seldom any more accurate than any other self-description from a player regarding injury. It's not good, but it's also not an immediate "oh s**t" moment, either. What we know about Beltre's hamstring is that he strained it running to first. He stayed in the game, but came out an inning later after the medical and field staff became aware of the issue. That's pretty typical and fits with a Grade I/II strain. Beltre's likely to wave off on tomorrow's All-Star Game, and with treatment, it's unlikely he'll miss much time. This will be tough to read until the team starts playing again, so have a Plan B if you're relying on Beltre.

Edinson Volquez (sprained elbow, ERD 7/20)
There's an element that's just sticking to the party line with Volquez. They're saying that he could have come back a couple of weeks ago, but that there was no rush. They think the back of the rotation has been fine, despite going a bit deeper than they wanted with injuries to Homer Bailey and Aaron Harang. They say that Volquez gets to make a nice start just after the break and can carry them into the playoffs without too much worry about workload. There's another element that is very concerned about the command-or lack thereof. The last thing to return after Tommy John surgery is always the proprioception, the "feel", and that impacts the command and, to some extent, the control. Teams in the division shouldn't offer much in the way of a problem, but Volquez's workload is going to have to be watched and his impact on the pen is the bigger concern. If Volquez isn't able to keep his counts down or the ball starts finding its way to the belt and higher, he's going to have real issues. As much as anything else, watch his ground-ball/fly-ball ratio and how often he can get an out in three pitches or less. Those, more than innings or pitches, will determine just how effective Volquez can be, which will in turn determine if he even has to worry about pitching in October.

Joe Mauer (bruised shoulder, ERD 7/15)
Mauer has spent the season dealing with one minor injury after another. It's clear what the cost of catching is doing to him when you look at the dropoff from last season. The batting average is one thing, but for me, it's the power that is being hurt by the injuries. His latest problem is a sore shoulder, which comes from a series of foul tips off his exposed throwing arm. Despite better equipment, that's the kind of thing inherent in catching that simply can't be prevented-unless you take Mauer out from behind the plate. (Oh look, a dead horse...) Mauer won't miss much time, if any, but the Twins are going to have to figure out a way to keep him a little healthier if they're going to keep pace with the White Sox and Tigers in the second half.

Jeff Niemann (strained back)
That Niemann has a career at all is testament to sports medicine. That he came out of his last start early with a tight lower back isn't that big a deal. The Rays have always been a bit cautious with Niemann due to his extensive medical history and the knowledge that the big guy's long levers make it pretty easy for him to get his mechanics out of whack. There's no real concern about his workload at this stage, though like most pitchers, going deep into the playoffs is going to be something of a strain. With Jeremy Hellickson putting on a show at the Futures Game, the Rays have an option if they decide to rest Niemann, David Price, or Wade Davis for a few games here and there, going with a de facto six-man rotation for a period of time. Of course, the trade deadline might change that possibility. In the meantime, Niemann is expected to take his next turn.

Scott Rolen (strained back)
Scott Rolen is never going to be "healthy" again, but as he's shown this season, he can certainly be productive when he's feeling good. New head trainer Paul Lessard is getting some of the credit for Rolen's relative health, but this is just an issue of maintenance and comfort. Rolen seems to understand how to deal with the issue, and when it does flare up, as it did going into the weekend, a couple days of rest and treatment can knock it down to a point where he gets back out there. The break should help Rolen get past any residual problems on the current cycle, but this will recur. The hope is that the Reds and Rolen will stay as productive and that the ratio of play/rest stays as high, but you could look at Rolen as a "sell high" candidate if you're risk averse.

Quick Cuts: The Mets continue to insist that Carlos Beltran will be an everyday center fielder once he returns. That makes his slim chance of staying healthy even slimmer. ... Josh Beckett was fine in a near 70-pitch rehab outing. He'll make one more, scheduled for Friday. ... Manny Acta says Shin-Soo Choo could be back by the end of the month. That's a very quick improvement for his injured thumb, so I'm not confident in that timeline just yet. ... Placido Polanco is expected to be activated on Saturday. ... Mike Cameron started three straight games heading into the break. That's a pretty good sign, but don't think you can write him in for more than four or five times a week through the rest of the month. He was off yesterday after a HBP left him with a sore wrist, but that shouldn't be a major issue. ... Nate McLouth is showing no issues with his concussion and will be ready to come off the DL after the break. ... The Pads are resting Mat Latos for over two weeks to keep his innings down. We'll see how he stays sharp. ... Domonic Brown strained his hamstring during the Futures Game, but no one seems to think it's serious. ... If you haven't picked up your copy of Football Outsiders Almanac, you're missing out. I've contributed an essay again, but this book would be on my iPad regardless. It's a must-have. For those of you that don't follow me on Twitter and like the NFL, I'll be doing NFL injuries for SI.com this season. I'm very excited about being back with them and have some great things planned.

I don't get why the Mets wouldn't have simply DL'd Reyes, knowing the ASB was in the middle of that stretch. He's hampered defensively, can't hit from the left side and most likely isn't going to be stealing too many bases. What's the point?

On Volquez, he's shown pretty solid control in the minors with a 28:8 K:BB in 31 IP. (8.1 K/9, 2.3 BB/9)

Of course, that's against AAA hitters who are more likely to chase out of the zone, but its promising nonetheless. Personally, you could put me in the group that would have like to see him come back as a reliever for the remainder of the season, as I think his stuff would player particularly well there, as opposed to that of Travis Wood or Matt Maloney.